Case Manager RN - Clinical Navigator for Holistic Care

Personify Health; California (MO); On-site; USD 4,822,000 - 5,510,000; Full time

Benefits offered by this job

Health benefits

Paid time off

Mental health support

Retirement planning

Career development

Diversity & inclusion

Job summary

Personify Health is seeking a Case Manager RN in California to guide patients through their treatment plans. You will assess clinical needs, review claims data, and collaborate with providers and families to ensure appropriate, timely care.

This is a patient-centered, outcomes-driven role within a team that values cost-effective healthcare at scale. Ideal candidates hold CA RN licensure with multi-state eligibility and have 5+ years in medical/surgical or acute care, including case management

Qualifications

• RN license required in California, multi-state license preferred.
• Minimum 5 years medical/surgical or acute care experience, with 2 years in case management.
• Experience with case management, emergency room, or critical care is valued.

Responsibilities

• Assess the whole patient: conduct thorough assessments across domains to build a clinical picture.
• Mine claims data for insight using processing tools to identify candidates for case management.
• Develop individualized treatment plans for standard and catastrophic cases with stakeholders.
• Track outcomes and adjust the care plan; report measurable results.
• Maintain ongoing communication with patients, families, and care teams throughout care.
• Advocate for patients to access quality care and reduce costs.
• Drive cost management strategies and reflect impact in reviews.
• Perform utilization review to ensure alignment with guidelines.
• Refer patients to wellness resources when appropriate.
• Maintain confidential documentation and prepare reports per policy and HIPAA.
• Mentor LVN colleagues as a clinical resource.

Skills

Claims data analysis

Clinical assessment

Care navigation

Microsoft Office

Eldorado

UM Web

Education

California RN license

Multi-state license

Tools

Eldorado

UM Web

Microsoft Office

Job description

Personify Health is seeking a Case Manager RN in California to guide patients through their treatment plans. You will assess clinical needs, review claims data, and collaborate with providers and families to ensure appropriate, timely care.

This is a patient-centered, outcomes-driven role within a team that values cost-effective healthcare at scale. Ideal candidates hold CA RN licensure with multi-state eligibility and have 5+ years in medical/surgical or acute care, including case management